The Teachers Retirement System of Texas (TRS) provides health benefits to roughly 90% of the school districts in the state. Known as TRS-ActiveCare, the state health plan for active Texas school employees offers three levels of coverage at varying costs to employees. Those costs — which the plans were originally designed to keep down — have risen steadily alongside other premiums across the nation; yet state contributions to the TRS have not increased.
That translates to higher out-of-pocket costs for teachers and faculty — and puts districts under pressure to contribute more to offset costs or risk losing talent. What’s worse, once a district enters TRS-ActiveCare, they can’t leave. Shopping around for alternative health plans or options to improve benefits is a futile exercise. For those districts that have resisted the broken promise of TRS-ActiveCare, understanding health plan alternatives now can make all the difference later. Here are three.
The lure of TRS-ActiveCare is in its individual monthly employee contribution rates. However, once family members are enrolled, monthly costs jump considerably. Health plans that offer high-performance or narrow networks typically come at a lower cost — as much as 35% less than traditional healthcare models. Intentionally designed to support value over volume, high-performance networks are carefully curated groups of providers that have demonstrated a consistent ability to improve member health outcomes while maintaining practice efficiencies.
The improved health outcomes coupled with cost-effectiveness have increased the adoption of high-performance networks by self-insured employers over the past four years by 267%. As districts look for a health plan built on a high-performance network, be wary of pretenders — broad networks cloaking themselves as narrow networks. For these major carriers, existing contracts may prohibit efforts to cherry-pick quality providers for narrower network solutions, leaving districts and teachers back where they started.
Many health plans (even those built on high-performance networks) lack quality controls for effective care and positive clinical health outcomes. Without those, the chance of readmissions, redundant services, or even medication error goes up, as do the costs. The clinical model of Affordable Care Organizations (ACOs) is designed to keep each member in the healthiest state possible by ensuring they receive the appropriate care at the right time and place, while avoiding unnecessary treatment.
Leveraging aligned groups of doctors, hospitals, and other healthcare providers that deliver coordinated, high-quality care based on an agreed upon set of standards and metrics, ACOs have been shown to reduce the total cost of care while improving patient health. Choosing a health plan with a strong ACO model can help districts save money, reduce out-of-pocket costs for teachers and faculty, and ensure educators feel good — about their health and their career choice.
Engaging patients proactively in their care journey is critical to see that they reach their optimal health outcome. Care coordination leverages a dedicated group of healthcare service providers (RNs, care managers, pharmacists, dieticians, etc.) who work with the patient, led by their primary care physician, to make sure the patient has the appropriate resources and continual guidance to adhere to their health management plan.
This approach leads to better health outcomes, sustainably lowers the total cost of care (TCOC) over time, strengthens the patient-provider relationship, and enhances member experience. TRS-ActiveCare does offer care coordination, but in only one of its coverage levels for districts in select counties. There are, however, health plans in Texas that offer 100% embedded care coordination, ensuring no teacher is left behind.
It’s important to note that there are Texas-based health plans that incorporate all three of these approaches. While being creative with benefits can seem risky to districts, these models are market-tested and have proven their value. Our educators are worth it — especially when you consider the alternative.